Amanda and Katie, women’s health physical therapists at Hulst Jepsen Physical Therapy, give us an intro into pelvic floor PT. What is it, what does an internal vs external pelvic floor exam involve, and what kinds of symptoms can pelvic floor PT treat? You can listen to this complete podcast episode on iTunes or SoundCloud.
Welcome. You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting. Let’s chat!
Alyssa: Hello, Amanda and Katie. So nice to see you both via Zoom!
Amanda: Hello!
Alyssa: How long have you two been back working together at the office?
Amanda: Well, yeah. It’s been kind of a crazy year, so we were off from the clinic March — end of March through — well, I was through June. I think you were about Juneish time. So, yeah, had the summer and some of the fall kind of off and on as well, but we’re back now at it.
I know. It’s nice to see people again! So Amanda and Katie are physical therapists with Hulst Jepsen. I will let you both kind of introduce yourselves, and then we’ll get into it!
Amanda: Awesome. Well, my name is Amanda Seymour, and I’ve been a physical therapist for about five years. Two years, actually coming up in a couple days, with Hulst Jepsen Physical Therapy, which I absolutely love. I love working with the whole body from toes to nose, but I would say more specializing in the women’s health pelvic floor rehab. I started taking classes around that topic about three and a half years ago. Herman and Wallace is a company that a lot of us physical therapists have gotten our continuing education from for pelvic floor rehab, and yeah, it was just one of those things where when I was at school, I never thought I would get into, but talking with friends once I was a physical therapist and realizing, yeah, a lot of my friends have had kids and now have pelvic pain or incontinence and realizing I want to do something to help them, and I don’t have the tools to do that yet. So, yeah, jumped on board with that about three and a half years ago, and it’s been fun being a therapist and sharing my passion just to help people.
Katie: And I’m Katie Thomas. I’ve been a physical therapist for nearly ten years, and I started noticing in my practice that a lot of women with back pain, pelvic pain, tailbone pain, were improving with regular physical therapy but not fully recovering. It was like that last 10 to 20% of them reaching their goals just wasn’t quite there. And often as treatment would go on and we would get to know each other, these women would start to mention urinary leaking or pain with sex or other pelvic issues, and I would try to get them into a pelvic floor physical therapist, but the waiting list would be, like, two to three months, which really just kind of broke up their care in an awkward way. So that’s when I knew I needed to learn more about the pelvic floor and be able to treat these patients myself. So I’ve also taken classes with Herman and Wallace, just like Amanda has, and I’ve been doing pelvic floor physical therapy for the last two years. And it’s just been really cool to see women get more control of their bladder, be able to enjoy sex again, and just so much more that we touch on, which is really cool.
Alyssa: So I think there’s a lot of unknowns with physical therapy. I always assumed physical therapy was something you went to after you got in an accident or you had surgery. You know, like you said, like shoulders or ankles. I never really realized it’s like, you know, you go to the chiropractor; you go to your doctor. It’s just like anyone can go for any ailment, really. And then I found about pelvic floor physical therapy, and I was like, what? Are you kidding me? How do women not know about this? So I guess how do you reach people? Like how do we even — I guess that’s the biggest question for any business, right, is how do you reach your target market and how do you educate people, and I feel like women just need to be educated that you even exist.
Amanda: Yeah. That’s a huge point because I know in other countries, pelvic floor rehab is probably much more well-known. It’s part of, like, the daily — especially postpartum, for example, like their six-week checkup with their OB or gyno. It’s like, hey, you’re doing good, baby’s doing good, or hey, you have these symptoms, and we need to send you to PT. And some even, they don’t have symptoms, and they’re like, hey, you need to go to PT, pelvic floor rehabilitation, just to make sure everything is okay down there after baby because things happen and you may not realize it until months down the road or years down the road that we could help with right away off the bat.
Katie: Yeah. I think that’s really common in France, but not quite as much here. And thankfully in West Michigan, we’re getting quite a few more gynecologists, OBs, who are screening for issues and are really good at referring their patients to pelvic floor physical therapy, and there’s been some great pelvic floor therapists in the area who have also done advertising and spoken with these doctors and really gotten things rolling in West Michigan. And so then I think also women are more comfortable talking to their friends and realizing, like, oh, there are a lot of people who are having issues with their pelvic floor. I’m not the only one. And there actually are things I can do about it.
Alyssa: So what is — you mentioned a screening, like, let’s say, at your OB. What is a screening — what do they screen for and what does that look like?
Amanda: At the OB exactly — I think it depends. I mean, I know I’ve had some patients who are like, oh, we just chatted, and they —
Alyssa: Asking about —
Amanda: Asking, yeah.
Alyssa: — leaking or having pain or anything like that?
Amanda: Yep.
Amanda: I think depending on if there’s, like, trauma during birth, they do maybe more of an external/internal screen, and some patients, I know, they chatted, more so, and nothing in regards to, let’s say, an internal pelvic floor assessment was done. And that’s something we’ll definitely chat on in a little bit here. Kind of as women’s health physical therapists, pelvic floor specialists, what we can provide that maybe, hey, your 20-minute appointment with your OB, maybe not — you can’t touch on that in that time. But, hey, we can have a full hour evaluation and sessions after that. We become kind of a team to work together on what’s going on with your symptoms. And that’s where I can now, too, kind of even explain what pelvic floor therapy is because I know that, hey, we’re so familiar with ankle physical therapy or shoulder rehab and, actually, pelvic floor, what even is that? And women’s health physical therapy is another term that we see a lot, and that’s definitely a big umbrella term. Even males are part of that women’s health therapy world. We do have a clinic or two — mostly we have, if a patient is wondering — okay, if it’s a male looking for pelvic floor help, just call one of our offices and they can get you into the right clinic. Here at the East Grand Rapids clinic, Katie and I don’t treat males, but we do have women’s health physical therapists who do within the company. But, yeah, it includes basically anything in regards to — it can include the low back, pelvis, sacroiliac joint, tailbone, like coccyx pain, pain with intercourse, pain just in the pelvis. We see patients with, like, endometriosis who have spasms in the pelvic floor. It can be pregnant females, it can be postpartum, old, young. We treat here probably anyone above 16 to 18. We don’t have — I hate to say this, but in the company, I don’t think we have anyone pediatric-certified.
Katie: I think we do have people who are doing pediatrics out at the Hudsonville office, but we don’t do any pediatrics here at our East Grand Rapids location.
Amanda: Right, yeah. So it does touch on every age. Because the pelvic floor is — they are muscles, and that, I think, I can go into. I know it’s a lot of information. But it’s muscles, and we treat any muscle in the body. And it’s function as these muscles basically are sitting in this pelvis like a bowl. They provide support for your pelvis. They provide support for the whole body. They’re there for sphincter control, meaning they close around any opening — your urethra where urine comes out; it closes around that. Closes around the vaginal canal, closes around the rectum. It provides stability on the pelvis, too. It provides for that sexual experience. And obviously, with posture and breathing, it’s a huge piece of it, which we’ll touch base on, as well. So we really try to tell patients that. Like, hey, you may not have ever heard much about your pelvic floor, but really it is just like bony prominence around this muscle group that’s just the same as your bicep or triceps. You just can’t see it. So that’s where it’s more foreign to people.
Katie: And once again, everyone has a pelvic floor. But we’re more focusing on women at this clinic, so women who are having urinary leaking for no reason; women who are having leaking with coughing, laughing, jumping; having urinary frequency, constipation. That’s a big one. Diarrhea. Organ prolapse. So when your uterus or your bladder might not be exactly sitting where it needs to be and you get a lot of heaviness in your pelvis. Pelvic pain. We see people during pregnancy, after pregnancy, women of any age. There are so many different women that we’re trying to reach out to.
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Alyssa: I’m trying to remember what brought me initially to your office, and I think it was — I had some swollen lymph nodes in that pelvic area, and then as I got to talking — Joellen was there at the time. We started talking, and, you know, you kind of learn, like, okay, oh, yeah, I do have a hard time doing jumping jacks when I work out, or I can’t really run very far or fast anymore. And I ended up doing some pelvic floor physical therapy with her in addition to the lymph node stuff, and it was kind of mind-blowing, like what I didn’t know about my body. You know, it’s just amazing what they don’t teach you in school. But learning about, like you said, breathing, and then she did an internal exam, and I think you two should talk about that, because I think that might be intimidating for some women, but it was really easier than my annual gynecological exam. But the things she taught me, the techniques she taught me, I can still do any time, and it’s not just a Kegel. It’s so different from what my mom used to do and told me to do. And I learned, and correct me if I’m wrong, that you can do Kegels too much or the wrong way and actually have a worse outcome.
Katie: That is definitely correct.
Alyssa: Talk about the difference, because you mentioned breathing, and that was a big part of what I learned, the breathing. And then maybe talk about that versus a Kegel, which everyone else thinks about, and then maybe talk about what an internal exam looks like.
Katie: Yeah. So we’re going to get more into some of the breathing, actually, as we talk about incontinence in our next podcast section, so we’re going to talk about incontinence completely there. So if we can save that question for that, because it’s a pretty big topic, actually, getting into breathing. But Amanda was definitely going to talk about, like, what to expect from a pelvic floor visit because we do know that it can be a scary experience not knowing what it’s going to look like.
Amanda: Yeah, definitely. And the fact that, yeah, Kegels — right, wrong. I think that’s where pelvic floor therapy can come into play to say hey, yeah, if you really have a tight pelvic floor — and that’s what we kind of help you to discover, to find out during the internal assessment. Is the pelvic floor tight? Is it weak? Is it boggy? I guess you could use that term. To know, hey, should you be someone doing a pelvic floor activation, aka a Kegel, or are you someone that should actually be trying to let those tissues kind of stretch and relax, because that’s where I think people get into trouble. They say, hey, yeah, I watched this YouTube, and I tried all the Kegels in all these different ways. Well, shoot, actually we need to help you with down regulation and kind of relax that pelvic floor. And that’s where an internal pelvic floor assessment does have a huge advantage to kind of say, hey, we can teach you about your pelvic floor during the internal assessment. We learned a lot about the pelvic floor to be able to decide the correct plan of care. But I will say not everyone is comfortable with an internal pelvic floor assessment, and we are totally fine with that. There are external releases that we can do on more of the global structures to help release the pelvic floor if it gets too tight or using those global structures to help activate the pelvic floor, too. But typically when someone comes in for an evaluation session, we get 60 minutes with you, and we definitely take a lot of time for history and getting to know you to build that rapport and to become a team at that point. We don’t necessarily say, okay, we’re diving into an internal assessment right away. It might just not be the right day or the right time. Maybe something about your symptoms is really emotional, and that first day just needs to be comfort level, coming into the clinic and starting you off with a lot of education and with your first home exercise program. But if we say, hey, if you’re interested in an internal assessment, let’s go for it, and if you feel comfortable with it. Typically, when you come to the clinic, wear stretchy clothes because we can kind of feel and see — I should say more so feel and get a good glimpse of how the pelvis is moving or the back or the hips. And then when it comes to the internal part, basically, we set up the physical therapy mat table. We have a pelvic floor room here at the clinic just dedicated to our pelvic floor patients. We try to make it really comfortable with artwork, essential oils; try to make you feel as calm as possible. And we try to make the space yours. So we don’t have stirrups. We don’t use a speculum, anything like that. It is just a gloved hand with a single digit that we actually use to kind of insert into that vaginal opening very carefully, very gently, and we look for your response right away. Painful, not painful. If we’re doing okay, we say, okay, here’s the right side of your pelvic floor. I’m touching that muscle. And that way you can kind of build a 3D image in your head of what your pelvic floor actually looks like, which I think is really helpful. During my first lab experience with the course I went to, I was really nervous. Here’s a stranger just assessing my pelvic floor. But afterwards, wow. I just feel so much more confident about how to relax my pelvic floor, how to activate my pelvic floor. Who knew that I had a deep hip muscle way back there, and someone was able to say, here it is, and now I just have that knowledge of my body so much more. So I think it’s helpful for anyone, even with someone who doesn’t have symptoms, just to know where their pelvic floor is. But definitely if you’re having symptoms, I think it’s really helpful, just emotionally, to know where your pain is coming from or why you have symptoms, because it’s overwhelming when you’re leaking or having pain with intercourse, and the first thought is, what’s wrong with me. And there’s nothing wrong with you. It’s just, hey, these are muscles, and something’s just not working right now, but we can help you get those to work.
Katie: Yeah. I’ve seen a lot of women who are having pain with sexual activity, and it’s starting to feel to them like it’s just kind of in their head, and so doing an internal exam can be very helpful because we can go in and actually touch one of the muscles or several of the muscles that are giving them issues and say, here. You’re not crazy. You feel how this is sore, just like your neck muscles can be sore? You’re normal. This is something we can work through. Here’s how we can fix it.
Amanda: Yeah. And I’ll say follow-up sessions — sometimes, yeah, we say, hey, I think another internal treatment would be helpful, or, you know, we’ll touch base on a little bit of what other treatment techniques are there. Because it’s not always just, oh, an internal session every time you come in. There’s a lot more to it.
Alyssa: Yeah. I remember doing stretches and all sorts of other things based on what she found with how my body works. So if someone wasn’t comfortable with the internal assessment, you had kind of said you could see how their hips and pelvis move. What else do you look for with someone who isn’t comfortable with the internal exam?
Katie: There’s so much to focus on externally, as well. So definitely like what you said, we want to make sure that the hips and pelvis are even, that the leg length is even, that there’s no rotations in the back. So we can work on getting everything nice and aligned. Because the pelvic floor muscles sit in the base of your pelvis and kind of hold everything together, if your pelvis is a little bit twisted or your back is twisted, that’s going to affect the tightness of the pelvic floor. So there’s so many outside things that we can do first. So we would just look at their back, look at their pelvis. We would work on different stretching techniques. We would take a look more at the groin muscles. We would instruct just in some self-relaxation techniques, some guided meditation. And then, I mean, there’s just so many different types of exercises and then a lot of education, as well. Typically, I would say that on the first visit, it’s pretty rare for us to do an internal exam because there’s just so much to talk about and so much of getting to know your body to do.
Amanda: And I think functionally, too, if someone’s having leakage with jump rope or jumping jacks, we can definitely assess that, like the performance of it, because that sometimes makes a difference, too. Hey, if you’re doing jump rope and you keep jumping backwards, it actually kind of shuts off that anterior wall of the pelvic floor. So some of those more functional things, that’s external and it’s fun to kind of work through with patients depending on their status of activities, too.
Katie: And if we’re seeing women postpartum and they’re doing breastfeeding, then there’s often a lot to look at also in the midback and neck and posture there, as well. So there’s so many things to address. Definitely don’t let any fears or concerns over an internal exam be what keeps you from coming to pelvic floor therapy. We’re never going to do anything unless you’re comfortable with it. I wanted to go back to when you were talking a little bit, Alyssa, about how you started pelvic floor physical therapy. So it sounds like you kind of noticed some stuff and were really in tune with your body, which is super great. We get a lot of women in like that, too. But a lot of people ask, like, how can I make a visit? One option is definitely to see your doctor, your gynecologist, and get a referral to come in to physical therapy. That’s definitely the easiest route to go for us. But you’re also welcome to just come into the clinic without a referral, as well. Just walk in our doors and schedule a visit. The State of Michigan allows us to see you then for either three weeks or ten visits, whichever one comes first. And then during that time period if we feel like you’re going to need more physical therapy, we can contact your doctor and get them to sign a referral, or we often do a big — for every patient, we do a big write-up and send it to their doctor just letting them know, hey, here’s what we’re seeing, just to make sure that we’re all on the same page, and as long as they sign that, that counts as a referral, too. So that’s definitely something that we can help people with for making access to pelvic floor easier, too.
Amanda: And I would say more and more people, like Katie said, are talking about it, so yes. Spread the word that pelvic floor rehab is around and that it is really helpful. I know a patient just came in the other day. She said, oh, I started following some — I think it was an Instagram physical therapist for pelvic floor rehab, and I was like, that is awesome. I’m not very good with social media, but I’m glad people are out there spreading the word on social media, too, because hey, got her help and got her in our doors for us to continue to help her hands-on and one on one, which is so exciting. But, yeah, definitely, that’s a big push to make that more the norm for females, to get them in.
Alyssa: So for our listeners in particular who are probably either planning to get pregnant, are pregnant, or are early postpartum, I would guess, what would you say would be your ideal time to see them?
Amanda: I would say during pregnancy, whenever I’ve seen people with stages prenatal way at the beginning, and they say, hey, can you help me make, like, a plan throughout my pregnancy, and I’ll see them once a week. I even had someone I saw, like, kind of every two weeks just to kind of check in, how are things going. Checking alignment, exercises. And sometimes I have females who come right before they give birth, too, because pain can become a factor, for sure. It’s fun when someone’s here earlier because you try to keep them from that pain level maybe later in pregnancy. And then postpartum, I would say really — I mean, six weeks out is a great time to come. I realize that time goes really fast when you just have a newborn, so we always say, hey, when you feel ready to commit to physical therapy, because obviously we’d love to have more than just — I think the eval is great, but then the follow up, too, I think is just as important for people to attend, and I know I’ve had patients who have tried physical therapy, you know, pelvic floor rehab, like four weeks postpartum and was just overwhelmed, really overwhelmed. So she came back at ten weeks, and it was all good. But I think, yeah, it’s fun to get six weeks out because then those muscles are ready to relearn what they’re supposed to do.
Katie: And we often say the six weeks because that’s normally when your follow up is post-birth, so you’ll have seen the OB and they can even give you a referral for pelvic floor physical therapy at that time, so that can be a great time. But it doesn’t have to be six weeks. I’ve seen a lot of women who tell me, oh, I saw another pelvic floor therapist six weeks out, and I just didn’t have the bandwidth to take care of myself and do this right now in the middle of trying to figure out how to be a parent, too. And that’s perfectly fine. Sometimes then we see women a year later or two years later or ten years later. It doesn’t matter. There’s something that we can do at any time. Honestly, it’s so important just how the woman feels and what works best for her and her lift at the time.
Amanda: Pelvic floor rehab is definitely needed. It’s the symptoms of kind of a pelvic floor dysfunction are really, really common. We know that 25% of even young women experience urinary incontinence. Just a few other stats here I just thought were mind-blowing as I was taking courses. One in seven American women ages 18 through 50 experience pelvic pain. So that’s — yeah, 1 in 7. That’s like, ask your friends. Ask your mom. Someone’s bound to probably share that same experience but just hasn’t brought it up in conversation. And more than 25 million people in the USA experience bladder leakage every day. Overall, pelvic floor disorders, whether that’s prolapse or incontinence, affect one in five women in the United States. So these are definitely muscles that need more attention. As we say, if you don’t use it, you lose it. And with birthing and whatnot, that’s some stretching of that pelvic floor, so to relearn how to use it — it’s like, hey, if your biceps has been stretched, like, a hundred percent, you probably need a little help knowing how to get that bicep back working again. And that’s what we’re here for, which is fun. It’s fun to partner with women and get them back to what they love doing, back on their feet with their kids. Definitely that’s the next podcast, to dig in a little bit more to the nitty-gritty of what the pelvic floor can do and Kegels and stuff.
Katie: Yeah. We definitely have more coming. Like I said, we’ll talk more about the breathing with urinary incontinence issues, and then we definitely want to talk more in depth about pain with sex and talk more in depth — we’re going to do an entire separate podcast just on postpartum concerns, as well.
Alyssa: Yeah, I’m excited to talk to you both a few more times. So anyone listening, we’ve got at least three more podcasts coming with these women. So if anyone wants to reach out — now, tell us, if anyone’s in the West Michigan area, how do they get ahold of you? But can anyone nationwide get ahold of you via Zoom? Or maybe not Zoom. You probably have a HIPAA — do you have something —
Amanda: Yeah. So we do have Telehealth with Hulst Jepsen. Right now, and I can double check, but when I’ve done Telehealth sessions in the past, it has to remain in Michigan. So we can treat anyone in Michigan, but they’re — you know, behind the scenes of why it’s just Michigan, I do not know. I’d have to talk to our HR. But as of right now, anywhere in Michigan, we can definitely do a Telehealth session, which I have done for a pelvic floor patient. I saw her in person and then because of the virus, she said, hey, I’d love to do Telehealth instead, and that’s worked out great for her. But otherwise, definitely going to our website, and you can take a look at all of our locations. We have about 19 different locations for general physical therapy. We have about five or six now clinics that offer pelvic floor rehabilitation, and it’s going to note it right there with the location with the phone number when you click on it. For Katie and I, we’re at the EGR location. We are here. Give us a call, and Lexi up front can definitely get you scheduled with one of us.
Alyssa: Great. Well, thanks for joining us today! We will record again about urinary incontinence.
Amanda: Cool. Thank you!
Katie: Thank you!
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